Survival Status and Predictors of Mortality in Severely Malnourished Children Admitted to Jimma University Specialized Hospital from 2010-2012, Jimma, Ethiopia

Abstract

Background: Although community based treatment of severe acute malnutrition has been advocated for in recent years, facility based treatment of severe acute malnutrition is still required. Therefore, information on the treatment outcomes of malnutrition and potential predictors of mortality among severely malnourished children admitted to hospitals is critical for the improvement of quality care. Objective: To assess survival status and predictors of mortality in severely malnourished children admitted to Jimma University Specialized Hospital from September 11, 2010 to September 10, 2012. Methods and materials: Retrospective cohort study was conducted at Jimma University Specialized Hospital. Primary data were collected from September 11, 2010 to September 10, 2012 whereas secondary data were collected from February 20, 2013 to March 22, 2013. Data of 947 severely malnourished children admitted to the hospital during the study period whose cards were found were reviewed. Data were analyzed using SPSS version 16 for windows. Bivariate and multivariable analyses were performed by Kaplan-Meier and Cox regression. Result: A total of 947 children were enrolled into the study giving response rate of 96.3%. A cure (improvement), death and abscond rate were 77.8%, 9.3% and 12.9% respectively. The median duration from admission to death was 7 days. The average length of stay in the hospital and average weight gain were 17.4 days and 10.4 g/kg/day respectively. The main predictors of earlier hospital deaths were age less than 24 months (AHR = 1.9, 95% CI [1.2-2.9]), hypothermia (AHR = 3.0, 95% CI [1.4-6.6]), impaired consciousness level (AHR = 2.6, 95% CI [1.5-4.5]), dehydration (AHR = 2.3, 95% CI [1.3-4.0]), palmar pallor (AHR = 2.1, 95% CI [1.3-3.3]) and co-morbidity/complication at admission (AHR=3.7, 95% CI [1.9-7.2]). Conclusion and recommendation: The treatment outcomes (improvement rate, death rate, average length of stay in the hospital and average weight gain) were better than most reports in the literatures and in agreement with minimum international standard set for management of severe acute malnutrition. Any intervention to further reduce earlier deaths needs to focus on children with the main predictors identified in this study